Green Medical Clinic
Organization Active NPI Family Medicine Physician · Cookson, OK
NPI 1801086715 · NPPES record last updated Nov 1, 2012
Key facts
- NPI
- 1801086715
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 9260 (OK)
- Legal business name
- GREEN MEDICAL CLINIC
- Practice address
- 23507 East Riverview Drive
Cookson, OK 74427 - Phone
- (918) 456-8989
- Fax
- (918) 456-7989
- NPI assigned
- Jul 26, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Lawrence Charles Green, M.D.
- Title
- Owner
- Phone
- (918) 456-8989
National Provider Directory
Locations
1607 S Muskogee Ave
Tahlequah, OK 74464
Phone (918) 456-8989
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 9260 | OK | Yes |
Addresses
Primary practice location
23507 East Riverview Drive
Cookson, OK 74427
Mailing address
1 Plaza South St
Tahlequah, OK 74464-4750
Phone (918) 456-8989
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D05217 | Other | OK | UPIN |
| 100093200D | Medicaid | OK |
Other providers in Cookson, OK
- Ronald David Brown
- Wendi Esposito-Worthington
- Ezpzhealing LLC
- Rance Head
- Karen Gail Nickels
- Charla Nofire
- Winston Perkins
- Robert E. Sanders
All providers in Cookson, OK · Family Medicine Physician in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 1, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.